Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Help for Headaches

Tuesday, 16 November 2010 02:43 PM

Question: My wife has had severe headaches for two months. We have been to our family doctor and to a neurologist, but, at this point, we have no answers. The headaches move from the forehead, to the ears, to the eyes, to the neck, etc. She has had MRIs of the brain and neck. Do you have any suggestions? The headaches worsen under fluorescent lighting.

Dr. Hibberd's Answer:

Headache treatment is usually very straightforward once your doctor has decided what is causing the pain. Migraine headaches are very common, and people with them will have normal MRI and CTT brain reports with normal blood parameters.

Treatment of migraines has advanced the last few years, and effective preventive and treatment medications are commonly available by prescription. In fact, the newest data supports that a single dose of 1,000 mg aspirin may be as effective as the prescription sumatriptan.

All migraines can be controlled, and in many cases can be completely prevented with judicious use of environmental controls and selected medications.

Not all migraine mandates the need for prescription drugs. You are advised to be under the care of a medical doctor for initial diagnosis and treatment recommendations. Avoid devising your own treatment plan without a professional consultation. Sometimes what appears to be a migraine may be another condition that may need a very different treatment/management plan.

Sudden headaches without an obvious cause must always be urgently addressed simply because we always fear missing the vascular headache seen with a leaking aneurism, vascular malformation, or hemorrhagic stroke. Remember, these conditions can occur at any age.

In migraine, pay attention to any triggers such as fluorescent lighting, strobes, etc. Avoiding triggers will minimize your reliance on medication. Some people are sensitive to nicotine, caffeine, and other additives, and elimination therapy is usually wise.

If your headaches seem to change pattern or worsen in the morning, or you develop new symptoms, always inform your doctor without delay. Sometimes those at risk for stroke or hemorrhage may have a period of new headache changes that may precede a major stroke or hemorrhage. These are appropriately called "sentinel headaches,” and may "signal" future problematic events in our brain (such as bleeding or stroke).

Cluster headache and tension headaches are just as disturbing and debilitating as migraine headaches when not treated properly. Often some migraine medications are also effective for the latter, but we usually rely more on episodic and preventive management for nonmigraine headaches. Cluster headache syndromes can be problematic for some, but work with your neurologist until a satisfactory response is seen. Always feel free to request a second opinion. If any consultants take offense with the mention of a second opinion, that is usually a warning sign to me to consider changing consultants completely.

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